Prediabetes Diet

From hopkinsmedicine.org

If your doctor says your bloodwork reveals prediabetes, you’re bound to have questions about what’s best to eat. People with prediabetes have fasting blood sugar levels that are elevated, but not to the point that they meet the criteria of type 2 diabetes.  

Key Points

• Prediabetes can often be reversed through lifestyle changes like healthier eating. Increased physical activity, with a goal of 5% to 7% weight loss.
• A balanced, sustained eating approach — not restrictive diets — is essential for managing prediabetes.
• The Mediterranean diet is recommended because it focuses on whole grains, lean proteins, and healthy fats.
• Reducing added sugars and saturated fats and choosing high‑fiber foods support healthier blood sugar levels.

Diet for Prediabetes — What foods should I eat?

A balanced diet is key to preventing prediabetes from progressing to type 2 diabetes. Rather than eliminating entire food groups or following fad diets, focus on healthy, sustainable eating habits that support long-term blood sugar control.

With that in mind, the Mediterranean diet is recommended for people with prediabetes, with its emphasis on whole grains, lean protein and healthy fats.

Other recommended resources include the diabetes meal planning recommendations from the Centers for Disease Control and Prevention and a version of the MyPlate guidelines issued by the U.S. Department of Agriculture and adapted by the American Diabetes Association (ADA).

The ADA’s version of the recommendations suggests these proportions for meals:

• 50% of the plate filled with non-starchy vegetables, such as leafy greens
• 25% with healthy carbohydrates, such as whole grains like brown rice, farro or quinoa
• 25% with lean protein, such as chicken, turkey, fish or tofu
• Incorporate fiber to reach a goal of 25 to 30 grams per day by eating a variety of fruits, vegetables and whole grains

Foods to Limit if You Have Prediabetes

In general, many nutrition experts highlight certain foods that tend to spike blood sugar more quickly and are worth limiting. These include:

• Sugary drinks such as soda, sweetened teas, energy drinks, and fruit juices
• Refined carbohydrates like white bread, white rice, pastries, and regular pasta
• Highly processed snacks including chips, crackers and packaged baked goods
• Foods high in added sugars such as candy, desserts and sweetened cereals
• Fried foods that are high in saturated fats and can worsen insulin resistance
• Limit saturated fats like fatty cuts of meat, butter and full-fat diary to support insulin sensitivity and instead have healthy unsaturated fats, such as avocados, nuts, seeds, canola and extra virgin olive oil. 

Prediabetes and sugar — How much is too much?

Carbohydrates are the body’s main source of energy. Glucose (blood sugar) fuels every cell in the body and is the brain’s preferred fuel. While your body needs glucose to function, eating too much added sugar and refined carbohydrates can raise your blood sugar levels and worsen your diabetes.

Blood sugar levels are key indicators of prediabetes, so it’s important to be aware of hidden sources of sugar. Added sugars can be found in many processed foods, including breakfast cereals, frozen meals, protein bars, sauces and salad dressings.

Recommendations for Limiting Sugar

The World Health Organization (WHO) recommends limiting added sugar to less than 10% of your daily calorie intake and ideally to 5% or less for additional health benefits. For someone following a 2,000-calorie diet, this means consuming no more than 50 grams (about 12 teaspoons) of added sugar per day, with an ideal target of 25 grams (about 6 teaspoons). 

The American Heart Association recommends even lower limits, advising women to consume no more than 25 grams (6 teaspoons) of added sugar daily and men no more than 36 grams (9 teaspoons) per day.

Practical Tips for Limiting Sugar

• Choose water or unsweetened beverages instead of soda, sweet tea, energy drinks, and other sugary drinks.
• Read food labels and look for added sugars in packaged foods, snacks, and beverages.
• Eat whole fruits instead of candy, cookies, pastries, or other sugary desserts.
• Choose balanced meals and snacks with protein, fibre and healthy fats to help reduce sugar cravings.
• Limit highly processed foods that often contain hidden sugars and opt for whole, minimally processed foods whenever possible.

The Dietitian’s Guide: The 5-10-11 Added Sugar Rule

Food Label	Added Sugars (per serving)	What it Means
Best	0-5 g	15 Choose these foods most often. They are the best choice for supporting16 healthy blood sugar levels.17
Limit	6-10 g	23 Enjoy in moderation. Look for lower-added-sugar options when available.24
Avoid	11 g or more	30 Frequent intake can contribute to blood sugar spikes and increase the31 risk of progressing to type 2 diabetes.32

What should I eat for breakfast if I have prediabetes?

Choose foods that have lean protein, healthy fats, and high fibre carbohydrates. For example: Oatmeal topped with berries and pumpkin seeds with 1% milk, offer a well-balanced meal.

What fruits should I avoid with prediabetes?

Whole fruits can be part of healthy eating for people with prediabetes because they provide fibre, vitamins and antioxidants. Aim to choose whole fruits instead of fruit juice, which can raise blood sugar quickly. Consult with your healthcare provider regarding grapefruit as it can interact with certain medications.

How to Reverse Prediabetes — Lifestyle

Research studies such as the National Institutes of Health’s Diabetes Prevention Program Outcome Study (DPP) has consistently shown that healthy eating, regular physical activity, modest weight loss can reduce your risk of developing type 2 diabetes by 34% for four years compared to placebo, which was an outcome of the Johns Hopkins’ diabetes prevention program.

Stay active

Physical activity can help prevent diabetes while boosting heart health. People with prediabetes should try to get at least 150 minutes per week of moderate to vigorous exercise or aim for 10,000 daily steps. Be sure to check with your doctor before starting exercise or levelling up your current physical activity.

Small Weight Loss, Big Health Benefits

Even small amounts of weight loss can have a benefit. The ADA states that moderate rate reduction of 5% to 10% of your body weight can significantly lower your A1C level. 

Get Enough Sleep

The relationship between sleep, diabetes, and weight gain is important to understand. Sleep deprivation has been shown to increase people’s cravings for sugary foods, so people with prediabetes should make sure they’re getting seven to eight hours of sleep a night.

Limit Alcohol and Avoid All Tobacco

Limiting alcohol can help improve blood sugar control and reduce the risk of progressing from prediabetes to type 2 diabetes. Alcohol recommendations are no more than one drink per day for women and no more than two per day for men. 

Avoiding all tobacco products is also important, as smoking can increase insulin resistance and raise the risk of diabetes-related health complications.

Stay on Top of Your Numbers

People with prediabetes should be vigilant about their laboratory test results. If you’re at risk or have prediabetes, make sure you follow up with your A1C level with a blood test at least yearly.

Dietary Supplements and Prediabetes

Be cautious with dietary supplements. Some supplements may affect blood sugar and interact with diabetes medication. For example, ginseng, gingko, and garlic have been studied for their potential effects on blood glucose, but the evidence is mixed. In high doses—particularly when taken as concentrated supplements rather than as foods—they may increase the risk of low blood sugar (hypoglycaemia) in people taking diabetes medications.

Before starting any vitamin, mineral, herbal, or botanical supplement, talk with your physician, pharmacist, or registered dietitian to ensure it is safe, effective, and appropriate for your individual health needs and medications.

Work With a Dietitian if You Have Prediabetes 

Because many people with prediabetes may have other health conditions, such as high cholesterol or high blood pressure, it’s important to individualize nutrition recommendations. 

A registered dietitian can help develop a personalized nutrition plan that fits your lifestyle, improves blood sugar control, and reduces your risk of developing type 2 diabetes. Ask your primary care provider for a referral to a registered dietitian or check with your health insurance plan to see if nutrition counselling for prediabetes is covered.

Reversing Prediabetes — Is it possible?

A diagnosis of prediabetes does not mean that developing type 2 diabetes is inevitable. Healthy lifestyle changes—including eating a balanced diet, being physically active, maintaining a healthy weight, getting adequate sleep and managing stress—can help improve blood sugar levels and may prevent or delay the progression to type 2 diabetes. In many cases, these changes can even help return blood sugar levels to the normal range.

“Every healthy choice you make is an investment in your future health. Lasting changes doesn’t come from perfection; it comes with small, consistent changes.”

Evangelina DiSpirito, RDN, LDN, E-RYT 500, is an outpatient cardiac rehabilitation clinical dietitian at Johns Hopkins with more than 25 years of experience in nutrition counselling, including diabetes education. She specializes in helping individuals with prediabetes, diabetes and cardiovascular disease make sustainable nutrition and lifestyle changes to improve blood sugar management, support heart health, and reduce the risk of developing type 2 diabetes.

Medically reviewed by Evangelina DiSpirito, RDN, LDN, E-RYT 500. 

https://www.hopkinsmedicine.org/health/expert-qa/prediabetes-diet

"Dear Doctor: Should I take weight loss drug with Type 1 diabetes and retinopathy?"

From oregonlive.com

Dear Dr. Roach: I’m a 73-year-old female who has Type 1 diabetes that began as Type 2 diabetes more than 30 years ago. I have a very strong family history of coronary artery disease, and I personally have a cardiac stent. I use an insulin pump and have good control with carb counting. I struggle with my weight (160 pounds at 5 feet, 2 inches tall) and with controlling my insulin dose. My A1C is 5.8%. I have ocular hypertension and some diabetic retinopathy. I receive Avastin injections in my eye approximately every two years.

My physician has ordered Mounjaro for weight loss. My concerns are my diabetic retinopathy and the diagnosis of Type 1 versus Type 2 diabetes. What are your thoughts on the safety of starting Mounjaro? -- C.D.C.

Answer: Type 1 diabetes is very different from Type 2. Type 1 diabetes is often diagnosed in childhood or adolescence and is an autoimmune disease that attacks the cells in the pancreas (islet cells), which make insulin. People with Type 1 diabetes have very little to no insulin.

People with Type 2 diabetes make normal or even high amounts of insulin. With Type 2 diabetes, the primary problem is resistance to insulin. Insulin can be used, but newer therapies are designed to reduce insulin needs.

Many people with latent autoimmune diabetes in adults (LADA) are initially misdiagnosed with Type 2 diabetes, and I suspect that this is your actual diagnosis. A diagnosis of LADA is typically made after age 30. (It sounds like you had problems beginning around age 40.) There’s no insulin requirement for at least six months, and blood tests confirm the presence of islet-cell antibodies. People with LADA usually have Type 1 diabetes.

You have disease in both the small blood vessels (Avastin is used for diabetic retinopathy, a small vessel disease) and large vessels (the stent in your coronary artery), which can happen with either type of diabetes but is consistent with Type 1. There’s strong evidence that GLP-1 drugs are helpful in preventing heart attacks in people with Type 2 diabetes but not for those with Type 1 (although they still may be helpful).

Your question is about the use of tirzepatide (Mounjaro when used for diabetes) for Type 1 diabetes. Your A1C is in the nondiabetic range; I don’t recommend new medication to lower your A1C further, so it seems like you’d be using it for weight. The expert opinion does recommend medicines like tirzepatide for weight loss in people with Type 1 diabetes who are obese, but your BMI of 29.3 doesn’t meet the definition of obese.

So, there is a safety issue in that even modest doses of Mounjaro could cause a drop in your blood sugar. Having an insulin pump (especially when combined with a continuous glucose monitor) can reduce this risk. But if you do go on Mounjaro, you should pay careful attention and regulate your carbohydrate intake to avoid ketosis (ketones in the urine, which show inadequate cellular nutrition and put you at risk for diabetic ketoacidosis). The normal dose escalations used for obesity or for Type 2 diabetes may be too aggressive, so your doctor should increase the dose very slowly.

You may also be at a higher risk for the nausea and vomiting that is common among people taking GLP-1 agents, although most people with Type 1 diabetes did develop a tolerance to the drug. In summary, Mounjaro may be effective at helping you lose weight, although your blood sugar and ketone levels should be monitored by an expert.

https://www.oregonlive.com/advice/2026/07/dear-doctor-should-i-take-weight-loss-drug-with-type-1-diabetes-and-retinopathy.html 

Preparing for Lows With Type 2 Diabetes

From diatribe.org

Key takeaways:

• People with type 2 diabetes commonly experience low blood sugar that can be fixed with a quick snack, but taking insulin or sulfonylureas raises the risk of more serious hypoglycemia.
• It’s important to regularly monitor your blood sugar and prepare for unexpected lows with a kit that includes a sugary snack, a medical alert identifier, and ready-to-use glucagon.
• Glucagon is an essential part of any kit, so if you haven’t had a conversation about it, bring it up with your healthcare team.

It’s scary to think about severe hypoglycaemia, but it can happen to anyone who manages their diabetes with insulin or sulfonylureas. 

If you have type 2 diabetes and use one of these medications, you should know what severe hypoglycemia is, how to avoid it when possible, and how to treat it when it occurs. Ideally, these conversations should be happening during check-ups with members of your healthcare team.

“Unfortunately, I think the data tells us that more often than not, conversations about hypoglycaemia are not happening,” said Dr. Rozalina McCoy, an endocrinologist at the Maryland School of Medicine.

This is part of the reason so few people at risk of severe hypoglycaemia are prepared for it if and when it occurs. One study found that only 3.5% of people who treat type 2 diabetes with insulin filled a prescription for glucagon between 2019 and 2023. If no one on your healthcare team has mentioned severe hypoglycaemia or ready-to-use glucagon, it’s a good idea to bring up at your next visit.

Defining severe hypoglycaemia

A hypoglycaemic event is a problematic dip in your blood sugar. All lows should be taken seriously and treated appropriately, but some are more severe than others. Level 1 hypoglycaemia, the mildest form, is typically defined as a blood sugar level below 70 mg/dL. 

Symptoms like dizziness, shakiness, sweating, hunger, and anxiety may occur during hypoglycaemia, but they become more common when levels drop below the level 2 threshold of 54 mg/dL. It’s important to note that some people have impaired awareness of hypoglycaemia and never experience symptoms, leaving them unaware of lows unless they’re using a monitor to track their blood sugar.

Level 3 or severe hypoglycaemia is when your ability to function is impaired, and you require assistance from another person to return to normal blood sugar levels. Often, this is thought of as something that occurs after you’ve reached level 2, but everybody has a different tolerance for lows.

“You can have someone have a blood sugar of 20 mg/dL, and yet they’re young and resilient and able to self-treat,” McCoy explained.

On the other hand, she said that older people, especially those who have developed additional chronic conditions that make daily life more difficult, may require medical attention for blood sugar levels as high as 70 mg/dL. 

When does severe hypoglycaemia occur?

Most cases of severe hypoglycaemia are associated with insulin therapy or sulfonylureas. These medications are very effective at helping your body manage blood sugar, but it’s still easy to run into unexpected circumstances (maybe a delayed or missed meal or strenuous physical activity) that leave you with lower blood sugar than you were anticipating.

“It’s a mismatch between insulin requirements and insulin presence in the body, but it doesn’t mean it was anyone’s fault,” McCoy added.

Monitoring for lows

According to the American Diabetes Association’s (ADA) Standards of Care, everyone who takes insulin should wear a continuous glucose monitor (CGM). These devices help track changes in your blood sugar over time and alert you when you start to go low.

You should discuss your target range with your healthcare provider. Generally speaking, most people with diabetes should be aiming to spend most of their time between 70-180 mg/dL, but McCoy said she advises her older patients who might have a harder time handling a low to treat 100 mg/dL as their lower bound.

If you worry about being overwhelmed by all the CGM data, McCoy suggested thinking about it as an alert for lows. Even if you’re not looking at it that often, a CGM will tell you if you’re consistently going below your target range and may need to adjust your insulin therapy.

A CGM can be helpful for anyone with diabetes, but if someone isn’t taking insulin, then monitoring their blood sugar with fingerstick tests can be sufficient.

“If they’re on a sulfonylurea, they should check whenever they’re not feeling well or whenever they think they might be having a low,” McCoy said.

Hypoglycaemia preparedness

When you go low, the ultimate goal is to get more sugar in your body. Even if you have a severe episode that requires a trip to the hospital, healthcare providers will be treating you primarily with oral carbohydrates or an intravenous (IV) drip of sugar.

If you’re alert and able to eat, then candy, soda, juice, and even honey and sugar packets can all be effective options for raising your blood sugar back to normal levels. Wherever you are, you should always have some sort of sugary drink or snack on hand.

Regardless, there may be times when you go too low too quickly to raise your blood sugar with food. In these cases, emergency glucagon is necessary. There’s also a chance that a hypoglycaemic emergency will move so quickly that you won’t have time to react to it on your own. It’s important to educate people you’re close to about hypoglycaemia and glucagon. 

In case none of them are around when you need help, you should also wear a medical alert necklace or bracelet that clearly states you have diabetes and may be experiencing a low. If you have a car, then you could also put a medical alert cover on your seatbelt. 

When to use ready-to-use glucagon 

The ADA recommends self-administering ready-to-use glucagon if 15 grams of sugar hasn’t resolved your low within 15 minutes, if you can’t keep food down, or if you feel yourself becoming confused or on the verge of passing out. 

If you do need to give yourself glucagon, be prepared to feel sick. Also, make sure to call your healthcare provider or 911. You may still need emergency medical attention or your diabetes medications adjusted.

The ADA also recommends using glucagon if you pass out, but someone else needs to administer it at that point. Make sure your diabetes emergency kit includes glucagon and is accessible and clearly marked for other people. Once again, you should start by making sure that people you’re close to know what glucagon is, how to use it, and where your supply is stored, but you also have to anticipate times when people you’re less familiar with will need to help you.

Make sure your glucagon is clearly labelled as something to use when you’re unresponsive. If you also carry insulin with you, store the two medications in separate containers and make sure the insulin is clearly labelled as something that should not be given to you while you’re unresponsive.

It’s possible that the person who finds you might not be comfortable giving you glucagon. However, McCoy said that a dose of glucagon is unlikely to cause much harm, even if hypoglycaemia isn’t ultimately the reason a person with diabetes has become unresponsive. 

Actual instructions for using glucagon will depend on what type you have. There are currently three options. A traditional mixing kit includes a vial of glucagon powder and a syringe of liquid, and the powder must be dissolved into the liquid at the time of administration. This takes time and creates the possibility for mistakes, so traditional mixing kits are not the best option for an emergency situation.

Instead, it’s better to have ready-to-use glucagon. When you talk to your healthcare provider, ask about Gvoke HypoPens and Baqsimi nasal powders, both of which are readily administered with no mixing required.

How to get glucagon

Glucagon is a prescription medication, so you’ll need to talk to a healthcare provider to get it. Ideally, when you receive a prescription for insulin or a sulfonylurea, you should also get one for glucagon. However, getting started on any new medication may involve a steep learning curve, and discussions about glucagon often slip through the cracks at early medical appointments.

“I’m not perfect. I run out of time, or I start insulin, and then I’m like, ‘Okay, I’ll talk about glucagon at the next visit,’” McCoy said.

If the clinician who prescribed you insulin or a sulfonylurea didn’t discuss glucagon, then ideally your pharmacist would bring it up when you go to fill your prescriptions. Pharmacists are legally obligated to offer consultations to anyone picking up medications, and they should know all of the risks and benefits of medications they’re dispensing. 

If your pharmacist sees your insulin prescription come in without a glucagon prescription, then they should ask you about it. Your pharmacist can also ask your clinician to prescribe glucagon without waiting until your next appointment.

Other members of your healthcare team, including diabetes educators and dietitians, can also get the ball rolling on a glucagon prescription, but if no one brings it up, don’t be afraid to initiate the conversation. For many people, pharmacists may be the best starting point for these conversations because you can walk into a pharmacy and request a consultation without an appointment.

For most people in the U.S., McCoy said that insurance will cover a new prescription of an autoinjector pen or a nasal powder, but coverage varies. If your plan doesn’t cover ready-to-use glucagon and you can’t afford it on your own, you may be eligible for patient assistance programs offered by Baqsimi and Gvoke. 

In general, insurance will cover a glucagon refill every year or after every use. Glucagon doesn’t last forever, so even if you haven’t used yours, make sure to check the expiration date and replace it when necessary. You’ll need a replacement every two or two and a half years depending on which option you choose.

The bottom line

Any person with type 2 diabetes may experience low blood sugar, but people who take insulin or sulfonylureas are particularly at risk for severe hypoglycaemia, which a person cannot resolve on their own without assistance from someone else. It’s important to regularly monitor your blood sugar and prepare for unexpected lows by carrying sugary snacks, a medical alert identification tag, and clearly labelled ready-to-use glucagon. 

Members of your healthcare team should discuss hypoglycaemia and prescribe glucagon if you’re taking insulin or a sulfonylurea, but if they don’t, initiate the conversation yourself. For many people, it may be easiest to start by talking to the pharmacist, who is often the most accessible member of your healthcare team.

https://diatribe.org/diabetes-management/preparing-lows-type-2-diabetes